德罗克西多巴或阿托莫克西丁用于重症心胸外科手术患者的耐药性低血压
Julia K Lessing1, Shawn J Kram1, Jerrold H Levy2
1Duke University Hospital, Department of Pharmacy, Durham, NC.
Journal of cardiothoracic and vascular anesthesia
|October 14, 2023
概括
德罗克西多巴和阿托莫克西丁在停止静脉注射血管活性剂方面没有显著差异,在ICU患者中不耐米多德林的ICU患者中. 然而,与单独的阿托莫克赛丁相比,单独的德罗克西多巴或单独的德罗克西多巴的组合改善了排泄后的生存率.
科学领域:
- 心胸重症监护室 (ICU) 医学医学
- 药理学和治疗学 药理学和治疗学
- 关键护理医学 关键护理医学
背景情况:
- 耐米多林的低血压是心胸重症监护室 (ICU) 患者面临的重大挑战.
- 静脉注射 (IV) 血管活性剂是常用的,但与潜在的并发症有关.
- 口服的血管活性药物,如德洛克西多巴和阿托莫克西丁,可以作为血管压缩剂断奶的替代品.
研究的目的:
- 评估德罗克西多巴或阿托莫克西丁在促进IV血管活性药物的停用方面的疗效.
- 评估这些口服药物对心胸ICU中耐性低血压患者的影响.
- 为了比较使用droxidopa,atomoxetine或两者在这个患者群体中的结果.
主要方法:
- 进行了一项单一中心的回顾性队列研究.
- 包括接受至少四次连续剂量德洛克西多巴或阿托莫克西丁与米多德林同时服用的患者.
- 主要终点是使用Kaplan-Meier估计进行分析的IV血管活性剂停止的时间.
主要成果:
- 在atomoxetine,droxidopa和组合组之间暂停IV血管活性剂的中位时间没有显著差异 (p = 0.259).
- 两组之间在ICU或住院时间方面没有显著差异.
- 与单独的阿托莫克赛丁相比,在存活到出院的患者中,接受了研究药物或单独的德罗克西多巴 (分别为90%和76.5%) 的比例更高 (44.4%,p = 0.028).
结论:
- 德罗克西多巴和阿托莫克西丁显示出作为口服药物的潜力,以帮助IV血管压缩剂在ICU患者中断断性低血压的断奶.
- 虽然在停止治疗的时间上没有显著的差异,但联合治疗或德洛克西多巴单一治疗可能会改善释放的存活率.
- 需要进一步的前性研究来证实这些发现并优化治疗策略.
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